Padma Shri and Dr B C Roy National Awardee

A four-year-old girl in Manipur in July 2016 suffered convulsions, high fever, and bouts of unconsciousness succumbing to Japanese encephalitis (JE), leading to the first death in the state from the viral brain infection that is transmitted by the Culex mosquito since 2010.

Japanese Encephalitis is the main cause of brain inflammation (viral encephalitis) in Asia. Fatality rates for severe infections according to the WHO are between 20-30%. Even when treated, it leaves serious neurological effects particularly in children and about 30-50% of survivors struggle to walk or contract other cognitive disabilities.

The virus appeared previously in Odisha in October 2012 after two decades, when 272 cases were reported and 24 deaths were registered. 626 symptomatic JE cases were estimated in Kushinagar Uttar Pradesh in 2012, with 139 confirmed cases, according to the Public Health Foundation of India.

The virus has a tendency to move to areas where there is stagnant water in paddy fields and also develops new habitats. Some subgroups of the Culex mosquitos have been found along the Yamuna banks in vegetation, confirmed the National Vector Born Disease Control Program (NVBDCP).

A 2016 Journal of Paediatrics study showed that the unofficial count of JE cases could be significantly higher than the reported data.

Routine immunisation covers JE in 197 districts with two doses administered over 18 months, and has proven successful mostly in South India (Andhra Pradesh, Karnataka, Tamil Nadu) and some districts of Bihar and Uttar Pradesh.

1. 72% of patients with sepsis, a fast-moving deadly illness, are seen by doctors in recent past representing missed opportunities to catch it early or prevent it.
2. Common conditions leading to sepsis are pneumonia and infections of the urinary tract, skin and gut
3. There is no specific test for sepsis and symptoms can vary, which means it is often missed. Three is no standard definition also.
4. Preventive Flu, meningococcal & pneumonia vaccines and washing hands can help
5. As over CDC over 258,000 Americans die of sepsis annually more than deaths from heart attack.
6. Sepsis is most common among older people, the very young and those with compromised immune systems 7. The condition can rapidly advance to septic shock
8. In 2011, sepsis was the No. 2 reason for readmissions, following congestive heart failure. {BMJ]
9. When sepsis is caught early, prognosis is very good, but mortality climbs to 25 to 30 percent for severe sepsis and 40 to 70 percent if septic shock occurs.
10. “Early” can mean within a matter of hours.
11. In septic shock chances for survival decrease 7.6 percent for every hour that it goes untreated.
12. Warning signals are fever, elevated heart rate, elevated respiration, low blood pressure and mental confusion that worsens within a few hours
13. Once in sepsis address low blood pressure by administering fluids or by IV drugs to constrict blood vessels and raise blood pressure.
14. Start broad-spectrum antibiotics till cultures are available
15. Outcome depends on fluids, blood pressure, antibiotics, source control and underlying health status.